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A study found that only about a third of people diagnosed with opioid dependence were tested for hepatitis C.

Emilija Manevska/Getty Images

Oct. 4, 2018

Teens and young adults who develop an opioid dependence and inject the drugs may also be exposed to hepatitis C infection, warn health officials who are calling for hepatitis C testing of high-risk opioid users.

The first study to closely examine the link between opioid dependence and hepatitis C risk was presented today at IDWeek 2018, the joint annual meeting of the Infectious Diseases Society of America (IDSA) and several other medical organizations, in San Francisco.

Intravenous drug use and needle sharing is a major risk factor for contracting hepatitis C, but few teens and young adults are screened for the disease, said the lead author of the study, Rachel L. Epstein, MD, a postgraduate research fellow in infectious diseases at Boston Medical Center.

Though less common, it's also possible to become infected by having unprotected sex with someone who has the virus or by using personal care items like razors or toothbrushes that come in contact with infected blood.

How the Study Was Conducted

The study consisted of an analysis of 269,124 teens and young adults, ages 13 to 21, who visited federally qualified health centers (FQHCs), which provide healthcare to underserved communities across 19 states, between 2012 and 2017.

Among 875 people who had a diagnosis of opioid dependence, only 36 percent were tested for hepatitis C. The testing found 11 percent had been exposed to hepatitis C, and 6.8 percent had evidence of chronic hepatitis C infection.

Healthcare providers may overlook the risk of hepatitis C in young people who abuse opioids because many users start out taking pills. But Dr. Epstein says some of those users eventually begin to inject opioids.

“In the midst of this current opioid crisis, where young people are most likely to transmit [infection], we need to be testing in order to diagnose and find cases and link them to care and treatment — and in the case of hepatitis C — cure them,” she said at a news conference. “We are probably underestimating the burden of youth with a known risk factor.”

Current guidelines on who should be tested for hepatitis C may fall short in catching high-risk opioid users.

“There is more of a perception that youth are less at-risk for hepatitis C,” Epstein said. “In order to reach these control and prevention goals, it’s vital that we increase testing rates among youth.”

The Food And Drug Administration (FDA) in 2017 approved the use of hepatitis C medications in teens. The medications can cure the disease after a few months of therapy. There is data that screening high-risk youth would be cost-effective, Epstein says.

Other News From IDWeek

In other news from the meeting, researchers found that a medication given to pregnant women with human immunodeficiency virus, or HIV, infection to prevent transmission to infants can be harmful.

Children whose mothers were prescribed the drug Sustiva (efavirenz) as part of antiretroviral therapy (ART) during pregnancy were 60 percent more likely to develop one of several birth defects and neurological conditions, such as microcephaly (a smaller than average head), seizures, and eye abnormalities, according to the study.

The findings emerged from the SMARTT (Surveillance Monitoring for ART Toxicities) study, which follows children to gauge the long-term effects of specific ART medications taken during pregnancy and determine which combination of medications is safest.

ART remains a vital strategy to allow women with HIV, the virus that causes AIDS, to pursue pregnancy safely. The therapy has resulted in approximately 1.6 million births of children who are not HIV-infected, according to the lead author of the study, Claudia S. Crowell, MD, an assistant professor of pediatrics at the University of Washington and Seattle Children’s Hospital.

“Antiretroviral therapy during pregnancy saves lives and reduces the risk of a fetus becoming infected to almost zero,” Dr. Crowell said in a statement. “Our ultimate goal is to determine which ART medications are safest for the baby and which should be avoided during pregnancy.”

Previous research suggested Sustiva was safe for the fetus. Those studies examined infant health at the time of birth. The new study found neurological damage shows up later. Only half the neurological problems were diagnosed by age 2.

IDWeek 2018 is the annual meeting of IDSA, the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS).